Aggressive Mooren's Ulcer: A Case Report

To report a challenging case of unilateral Mooren's Ulcer (MU) in a 47-year-old male, underscoring the complexities involved in its diagnosis and management. Given the rarity and severity of MU, its idiopathic nature and the absence of a well-defined etiology and pathogenesis, this case highlights the critical need for a tailored therapeutic strategy. The approach of combining immunosuppressive therapy, conjunctival peritomy, and amniotic membrane transplantation (AMT) reflects the importance of adaptable and patient-specific treatment plans in managing the potential severe visual consequences of MU and its progression towards central extension and ocular perforation.

Ophthalmology department of a tertiary hospital in Barcelona, Spain.

A 47-year-old male with intellectual disability was brought to the emergency room due to progressively worsening left ocular pain and hyperemia over the last two weeks, without prior ocular trauma or systemic illness. Following a comprehensive assessment and consultation with Rheumatology to exclude other etiologies, he was diagnosed with MU.

He initially received systemic steroids and topical mmunosuppression with tacrolimus, followed by oral Mycophenolate Mofetil due to due to lack of response. Surgical intervention became necessary after detecting a descemetocele by anterior segment optical coherence tomography (AS-OCT), at imminent risk of perforation. The procedure included conjunctival peritomy and three tailored freehand amniotic membrane (AM) graft layers, plus an overlay graft  to encompass the entire cornea. Despite post-surgery stability, a self-sealed microperforation led to another AM graft with a greater number of layers. The ulcer stabilized and epithelialized, yet continuous immunosuppression was necessary, highlighting MU's chronicity and bilateralization risk.

In conclusion, the management of MU, underscores the necessity for a bespoke therapeutic approach. The case highlights the critical importance of tailoring treatment to each individual, incorporating a combination of topical and systemic therapies, and, when warranted by rapid disease progression or the threat of corneal perforation, early surgical intervention. Furthermore, the significance of interdisciplinary collaboration and diligent patient monitoring cannot be overstated, owing to the protracted nature of MU and the potential for recurrence. This comprehensive strategy is pivotal in addressing the unique challenges presented by MU, aiming to mitigate its impact on patient vision and quality of life.